Message Board

Messages which ask specific questions will be responded to by the relevant director within 5 working days.

Date: 21 August 2006
Subject: Vertical Integration Message Board
Question: As a member of PCT staff I remain concerned that community services and primary care will become more isolated as vertical integration progresses. There seems to be a focus on the Barnstaple area, North Devon is a large area and the outlying localities are vulnerable to isolation. It would seem to make more sense as community nurses move towards integration with primary care that these services remain part of the wider Devon PCT. I feel this would promote closer working in GP practice and enhanced services for patients in the same locality, especially where they cross over the border of the wider PCT.

Response: Many thanks for your query. You do not make it clear why you feel community services will become more isolated as a result of being integrated, so we are unable to answer that aspect of your question. You also say, that there ‘seems’ to be a focus on Barnstaple, but without more details other than acknowledging that Barnstaple is the biggest urban centre in North Devon and the HQ for the acute trust, we can’t offer any explanation on that either.

However, most of your other concerns will be addressed by the work which is underway to draft a service specification for each community service currently provided by the PCT. This means that the exact size, cost, distribution and type of service which is currently being provided will be recorded in a service level agreement (SLA) and signed by both organisations before the transfer. For example, the Physiotherapy SLA will constitute a contract with the commissioner on how much the service currently costs, where it is currently provided and by how many staff, what standard the service operates at (i.e. appointments within 48 hours etc) and an indication of the future strategy of the service. This agreement has the effect of protecting the budget for community services and holding the acute trust to account for delivering theses services to the exact spec.

If we take community nurses as an example the strategic direction for the service is for further integration within practices to develop primary care nursing and this is identified within the service specification. As community nurses move towards integration with primary care, it therefore makes no difference whether staff remain with the PCT or transfer to NDHT as the services are underpinned by the SLA. The direction of travel and strategy for that service will be the same whoever provides the service. What is a key driver for the vertical integration, however, is that the North Devon health community retains control of its own services, and we do not delegate this responsibility to a Devon-wide PCT. Any service will be reviewed by the commissioners to make sure it offers the best service to patients and takes advantage of new developments and hopefully this will counter any feeling that services are isolated.

Date: 8/10/2006
Subject: Acute Services review Feedback Form
Question: Positive – To have services controlled locally.
Negative -What will happen to therapy jobs if Durrow propsal goes ahead? Very concerned that after vertical integration therapy jobs will be at risk especially at NDDH.

Reaction: Very concerned about rehab and therapy jobs (eg Occuaptional Therapy), and how therapy will be part of the Durrow proposals especially at NDDH.

To clarify, the Durrow proposal looks 15 years to the future and gives North Devon a vision for hospital services. We are unable to offer any clarity over what therapy services will look like in 15 years time.

The change that is being proposed this year is Vertical Integration which sees the budgets and staff for therapy services across acute and community being combined. In terms of patient care this means a better and more joined up pathway.

Your question doesn’t say why you are concerned about loss of jobs at NDDH. Understandably there is concern from staff working at NDDH that due to the current financial difficulties, their jobs are at risk. Please reply with more detail about your concerns so we can answer this question in more detail. In the meantime, the Q&A on Vertical Integration (on Tarkanet), may answer some of your queries.

Date: 13.7.06
Subject: Vertical Integration Feedback Form

Question: The following is taken from Staff express 21:

How will people be identified for redundancy?
When the new team structures are agreed, a process of appointing people to posts in the new structure will take place. This will be based on skills, qualifications and experience and consideration will also be given to individual redundancy costs.

MY QUESTION: Does this mean that staff will have to reapply for their jobs?

Date: 24.7.06
Subject: Acute Services Feedback Form

Reaction: Last Thursday (13th July) I posted a message asking if NDHT staff would have to reapply for their jobs as part of the Acute Services Review. As yet, no answer has been posted. Is there a reason for this?

Response: Apologies for the delay in answering this question, there is nothing significant in the delay other than the HR Director was on annual leave and therefore unable to respond within the usual 5 days.

The acute services review is a report which looks forward 15 years to the future and will give North Devon NHS organisations an indication of what is possible both clinically and financially. This timescale gives us a chance to start working towards that goal in an achievable time frame.

The Acute Services Review is looking at service design not individual staff numbers. Until we have a view of what the service may look like in the future, we are unable to describe the impact it will have on the workforce structures.

However, your question relates to the recent news that as part of the Trust’s turnaround plans (to get back into budget) the Trust has worked up a number of action plans. All of which require us to change the way we work and will inevitably mean we need to restructure the workforce. The staff briefings at the beginning of July were to give staff advance warning of the changes coming soon.

As stated in the answer given in the original Q&A, whether or not staff will have to apply for posts in the new structure will only be clear once the skills and qualifications needed by the organisations have been decided. We might know now that we need x number of nurses, but we do not know what skills and abilities the organisations needs them to have. Projects that staff are currently working on such as the bed reconfiguration, theatre efficiency projects and medicines management, require the same staff to work differently. It is unlikely that staff will have to reapply for their existing jobs as the idea is that during the change process, we change and adapt the way we work so these jobs will evolve and develop to allow us to better respond to patient needs.

The trust will try to avoid redundancies wherever possible.

It is easy to confuse what is happening within the Trust in terms of implementation of the Ernst and Young cost saving action plans, Vertical Integration where the Trust takes on some community functions, and the future outlined by the shortly to be published Acute Services Review report.

The Trust understands that there is confusion and is doing its best via this message board, by ‘asktheexec’ email, staff briefs and face to face meetings to explain the issues to staff. If we can do more for you, your team or your directorate, please let us know.



Date: 5.7.06

Subject: Acute Services Feedback Form

Reaction: From the information I have read so far, it would appear to me that the NDHT will eventually disappear. I refer to the vertical integration and then later the “full integration with primary and community care”. At this point, will the resulting (I assume) PCT be managing all services in North Devon, including the new build Barnstaple community hospital / health plaza?

Response: The North Devon PCT, NDHT and SHA exec teams have stressed on many occasions that the purpose of the financial turnaround plan and the Acute Services Review is to ensure that an acute hospital service is protected in North Devon. NDHT will not eventually disappear in terms of services provided, name or staff. What may disappear is the building as one of Durrow’s proposals is to relocate it to a more purpose built location and facility.

More complete integration with community and primary care is essential to the quality of patient care in North Devon. Patients do not distinguish between healthcare provided by primary care (GPs), PCT community care (physio or Community Hospitals) or NDHT acute care (surgery, A&E etc). It is stated as a clear vision for hospital services to become more integrated with GP and community services to ensure the patient’s experience is improved and that their care is continuous between NHS organisations.

The North Devon PCT as we know it will cease as of 1 October 2006. The new Devon PCT will take over the responsibility of commissioning services from the providers in each location (RD&E, NDHT and so on). This means that NDHT becomes the main supplier in North Devon of acute and community care. Commissioning is not managing. Commissioning is the process of ‘buying’ services for the local population at a pre-specified quality, cost and quantity. By taking over the North Devon PCT’s community services, NDHT adds £16m in extra business and takes on the responsibility of managing and developing these services.

The Vertical Integration proposal has been presented to both PCT and NDHT boards and is now subject to formal consultation with PCT staff. If agreed, the transfer will occur on 30 September 2006.

Subject: Acute Services Feedback Form

Question: There seems to be little account taken of the fact that this is a rural area and that many people will not have access to services Why is this ?

Reaction: The changes do not seem to recognise the needs of this area ,they also seem to be a forgone conclusion as yet what other options are there .

Response: The purpose of the Acute Services Review is to find a sustainable model for a small and rural District General Hospital, based from Barnstaple. It is not clear what you mean by people not having access to services in future. Why wouldn’t they? The idea of this project is to secure and protect health services into the future. Yes, there are particular issues that make you take a more flexible approach to delivering healthcare services in rural areas, but ultimately this will benefit patients as it means that health professionals: consultants, doctors and nurses, will work more closely to ensure that everyone has access to integrated services.

Durrow consultants have given us their initial recommendation. They are convinced that a gold standard health service in North Devon is achievable. They believe that 10 years hence, the patient experience will not be much different to what it is now: 80-90% of existing elective surgery will still completed in Barnstaple and at the core of the service will be a 24/7 emergency assessment centre.

However, this proposal is not a forgone conclusion, nor has it been agreed locally. Durrow’s proposals are formative ideas only at this stage. Their brief was to determine a sustainable future for acute services in North Devon in response to the underlying £8million deficit position of the Trust. At this stage, the two NHS Trust have made these recommendations available to the local population so they can give their feedback (hence this messageboard). No decisions will be made without full and proper consultation. Most importantly it is the Trust Management Board and the new Strategic PCT for Devon who must make the final decision.

The DVD of the presentation will be available shortly which may help explain these issues in more detail. Please contact us again if you wish to receive a copy


Date: 22.6.06

Subject: Acute Services Feedback Form

Question: There appears to be no mention of the provision of path lab services, in the Durrow proposal. The current service is excellent providing every day and specialist results in very quickly . The laboratory teams make huge efforts to speed through urgent specimens and are a great source of information and back up, liasing with other areas as necessary. The histopathology service especially is a local treasure ensuring that patients do not wait long for results. How do Durrow and NDHCT and NDPCT see the future of provision of the full breadth of Pathology and transfusion services to meet local needs?

Response: We are aware that there were a few gaps in the initial proposals from Durrow. At the moment, the proposal from Durrow does not provide this level of detail. However, we have forwarded this question directly to Durrow and a response will be available shortly.


Date: 21.6.06

Subject: Acute Services Feedback Form

Question: We take your point regarding incorrect media reporting but the public feel that MIU out of hours has not been mentioned.
Are they expected to continue to travel for treatment which causes hardship when paying for taxis etc.
Public transport is unavailable after 8.20 pm (approx)

We understood that the NHS plan and the Patient Led NHS was to bring services to people near where they live, not remove a service.

Torrington will continue to have a population growth so we feel that forward planning for out of hours MIU tratment centre is essential.

Response: Minor Injury Units are not part of the discussion under Acute Services Review. If you have any further queries about out of hours care, please contact the PALS service on 01271 341 555.

In the meantime, it might help to clarify what Minor Injury Units are: MIUs are locally based walk-in centres which treat minor injuries such as cuts, burns and sprains. Any injury or illness more serious and which occurs after the Unit’s opening hours would need to be seen by the A&E department in Barnstaple. Bideford is the only 24 hour Minor Injury Unit in North Devon so it is inaccurate to say that we have removed a service from Torrington.

We agree that out of hours services are essential, which is why we have an agreement with Devon Doctors to provide GP services to the population of North Devon after surgery opening hours. Depending on your illness of injury you will be advised over the telephone or directed to a treatment centre. Where medically necessary, the out of hours GP will come and see you at home. Devon Doctors’ number is recorded on your GPs answerphone.

For any further queries, please contact Katherine Smith on 01769 575 157.

Date: 18.6.06

Subject: Acute Services Feedback Form

Question: I am very concerned that our questions given at the meeting of May 23 have not yet been fully answered.

I also show disappointment that the press have had information regarding MIU at Great Torrington, yet staff have not been consulted in a proper manner.

The general public show concern that the statement given to the local media does not address the out of hours problem of MIU in Great Torrington

Response: We are aware that the feedback has been too slow. We are working to resolve this as quickly as we can.

Regarding the Minor Injury Unit (MIU) in Torrington, the media were present at a Town Council meeting where the PCT’s Chief Executive, Jac Kelly, presented the PCT’s view of future Torrington health services. The media incorrectly reported that the MIU plans had been decided and that the local GP practices would take over the service from 1 July. Staff and the GPs have known that the PCT was working towards this for some time and there has been plenty of staff involvement. All that was in error was the way the media reported that this was a ‘dead cert’.

Regarding the second point, the question needs to be more specific as to what the out of hours ‘problem’ is. As far as the PCT is aware there is no problem with the residents in Torrington getting out of hours health services, either from Devon Doctors, Out of Hours Pharmacists or the A&E in Barnstaple. As stated when we temporarily closed the MIUs in January 2006, only 8 people a week used the MIUs and they were not an efficient use of NHS money. The aim of locating the MIUs in the GP practices hopes to ensure people use the Unit appropriately and receive a much better, dedicated service which doesn’t rely on nursing staff having to leave patients on the ward whilst they attend to whoever came through the door.

Date: 9.6.06

Subject: Acute Services Feedback Form

Question: Why is it not more cost effective to develop the site the hospital is now on to include the additional facilities if anyone believes they are necessary. As the town is going to be clear of traffic jams! after the new road developments, there is no reason the Ambulance station could not be on or near the NDDH site. What are the cuts in service that will make this development any more viable.

Reaction: That they be confined to the area that I presume the proposed hospital/recreation area is going to be built on ie the old Barnstaple rubbish tip.

Response: the simplest answer to this query is that you cannot simultaneously build and knock down on the same site. Building on another site makes the logistics of transferring patient services to a new building very easy and less disruptive to patients.

Also, the Durrow model includes well being and fitness within the same site and as a result needs to be accessible and nearer to the town centre.

Date: 2.6.06

Subject: Acute Services Feedback Form

Question: It would be an amazing opportunity to begin with a clean sheet and design a service suitable for the future needs of the local population.

However, as the proposal comes without the detailed information on current and future health needs, delivery models or finance info it is difficult to judge whether this is the solution to the problems that exist within North Devon. I would certainly welcome anything that brought primary and secondary care together to provide a seamless service. Increased home services and single rooms are certainly desirable but are they affordable given the UK funding mechanisms?

Response: We agree, the one positive aspect of this financial crisis is that it has made us go back to the beginning and build a health service from scratch. It is an exciting opportunity.

More details of the finances behind these proposals will become clear by the beginning of July.

Date: 25.5.06

Subject: Acute Services Feedback Form

Question: Is this private health provision and Trust merger by another name.

Reaction: I am mortified that in an area of growing population and needs NHS services are to be axed and put effectively out to private tender. The knock on effect to the local economy will be devastating as people leave North Devon in droves!

Response: The static population in North Devon is 160,000 and this figure increases by approximately 3% per year. This is not excessive.
The health services in North Devon need to be redesigned and modernised precisely to protect the future of an NHS service in North Devon. The Government has made it very clear, that if an NHS Trust does not offer the taxpayer value for money and continuing efficiency, the private sector will be invited to tender for those aspects of service which they can provide more efficiently and cheaply.

However, the principle of the NHS ‘free at the point of need’ still applies. It would still be an NHS service, but one that is provided by a private contractor to the same or better standard than previously.


Date: 24.5.06

Subject: Acute Services Feedback Form

Question: The NHS is a major employer in North Devon; to what extent does the local economy depend on a viable general hospital?

Can we not attract income to the trust by investing in some other aspect of elective care much the same as the DTCs to utilise our resources more efficiently and support aspects of acute care that are more expensive?

An acute assessment unit must surely have intensive care facility and be staffed accordingly. In an area where the population is smaller and acute care needed less frequently is it not better to have a regular throughput of elective cases to maintain staff proficiency.

Response: The population in North Devon is 160,000. Most District Hospitals operate on serving a population of at least 250,000. This means that you cannot expand the number of elective services offered as a) there is not the population to support the service, consultants, nurses and supporting admin functions and b) it has been seen that patients from elsewhere in Devon/South West will not travel to North Devon for elective treatment, therefore we cannot expand our ‘customer’ base.

Date: 24.5.06

Subject: Acute Services Feedback Form

Question: After attending the open meeting on Tuesday lunchtime, though I welcome the ‘brave new world’ can we be shown where this private capital is to be sourced from?

Reaction: Unsympathetic to the plight of staff and services in NDDH. Ok in the cold light of days things need to change that’s a given, but the spin with regards to the current hospital and the statement that we would not want to lift what we have lock stock form the old hospital into the new site and the problems this would bring. Caused concerns from those NDDH staff members present.

Response: Durrow Consultants are currently in the process of scoping the finances behind the Acute Services Review. This is not just the finances of a new building but of changing and redesigning services to be more efficient and value for money.

What we heard at the stakeholder days on 23 May were Durrow’s proposals. No decision has been made and unless the finances stack up and there are clearly identifiable benefits to patient care, Durrow will be asked to review the proposals.

We understand that some of Durrow’s proposals were quite radical and unsettling for staff who work at the hospital. The only thing to say to reassure staff is that the principles behind all the joint pieces of work being done by the PCT and NDHT management teams aim to achieve a viable District General Hospital and community services for North Devon.

Date: 24.5.06

Subject: Acute Services Feedback Form

Reaction: I am not in the least surprised by these new proposals. Approximately 2 years ago I was at a study day where the future of the NHS was discussed. I found the meeting at that time to be innovative and exciting. I believe the future of healthcare has to change -go in another direction. At present staff are experiencing a lot of anxiety and pressure. All I ask is that you help to ease that anxiety by ensuring we are kept informed before the press and I mean fully informed –that staff are reassured about there future employment. I feel if this is handled in the right way people will accept the proposals outlined yesterday 23rd May. By the year 2010 there will be a lot of natural wastage, a large proportion of the nursing workforce will be reaching retirement age (myself included) do not alienate the staff you have remaining as there will be fewer experienced nurses around. I do hope that I will be still employed albeit in a very part time capacity when this change takes place.

Response: many thanks for your comments. Both the PCT and NDHT are committed to keeping staff informed at all times and are about to launch a Turnaround Newsletter which will be monthly and update staff on progress.
In periods of change, it is natural that people have opinions and express them to other colleagues, groups and the media. The PCT and NDHT cannot and would not want to control or hinder this expression as it is a good way for all the issues to be aired openly. Staff who hear an opinion and who want to check its truthfulness should use this message board to get the definitive answer.

Last updated: October 3, 2017